How To Find A Path Off The Dreaded Diet Plateau

Chances are that if you've ever lost weight following a strict diet and exercise regimen, you've also reached the diet plateau. On that lonely plateau, pounds never seem to melt away, no matter how hard you try to shed them.

You're not alone. Consider the plight of Susan Carierre. When the 5-foot-6-inch Carriere hit 230 pounds, she decided to enroll in a weight-loss program at the Pennington Biomedical Research Center near her home in Baton Rouge, La.

"My weight went up and down for years," says Carriere, 62. "I just couldn't keep it off." Over six months in the Pennington program, she finally dropped more than 50 pounds. "I was ecstatic," she says.

But then the scale got stuck at 181 pounds.

"It wouldn't move," Carriere says. "I was doing the same low-calorie diet, the same food every day and sticking to my daily walking." The scale stayed stagnant for weeks. "Why am I doing this? If I'm not making any progress, what's the point?" Carriere says she was thinking. "I might as well just go out for dinner, and if [my] husband is having fried food then I might as well have fried food!"

Carriere's frustration is echoed by most people, says Eric Ravussin, an obesity researcher who directs the Pennington center. There's no question there is a diet plateau, Ravussin says. "Four to six months into a diet program, this typically happens."

Even a weight loss of 10 pounds will set the body up to fight back. Ravussin says. Any significant weight loss means the body is smaller and needs less fuel to walk, go up stairs, jog or get out of a chair.

And less fuel burned means fewer calories needed. So if you've been on a diet of 1,500 calorie a day, perhaps your slimmer body now needs 300 calories less per day. That means you have to decrease your daily caloric intake — perhaps by as much as 300 calories, down to 1,200 calories a day — if you want to continue losing weight.

On top of that, metabolism slows as the body begins to combat what it interprets as potential starvation. So it begins to burn the calories it's getting more slowly. In Ravussin's research, he has found that metabolism slows even if dieters have maintained muscle mass. That's because the body is now using calories more efficiently. "It's like going from an old Ford to a Prius with a more efficient engine," he says.

And a more efficient engine isn't a bad thing. It means the body has adjusted to its new lower weight. "The diet plateau is the new set point," says Dr. Lee Kaplan, director of the Massachusetts General Hospital Weight Center in Boston. "So when you go to a healthier diet your body says 'Oh, this is good. Let's live at a lower body fat, and let's live at a lower set point.'"

The good news is that as long as people stick to the diet and exercise program that got them to the new lower set point, they'll maintain the new weight. But return to eating more and exercising less, and the weight will come back.

But what if you want to continue losing? What if the new set point isn't your goal? In the case of Susan Carriere, the 181-pound plateau was 20 pounds higher than her goal of 160 pounds.

"If you want to get below the new set point, you need a different approach added to the diet and exercise program you're already on," says Kaplan. "We call it speed dating obesity therapies," he says. "If one approach doesn't work, we try another one. We try a different diet. We add exercise or change the type of exercise. We encourage better sleep health. We encourage decreased stress."

Inadequate sleep and lots of stress often increase appetite and getting these things under control can help, Kaplan says. "We try to find the best therapies for each individual," he adds, stressing that everyone is different and may respond differently to various approaches.

But pretty much everyone agrees that exercise works for most people. That's because bigger stronger muscles burn more calories, says Kaplan. "If you're on the treadmill every day, you may burn a couple of hundred calories a day from being on the treadmill, but you may burn 600 or 800 extra calories throughout the rest of the day when you're not on a treadmill, because bodies with healthy muscles work better."

For some people, simply persevering through a diet plateau works eventually. That's what happened to Carriere who, after four weeks of not losing any weight, got on the scale one morning and had dropped three pounds. "It was like icing on cake," she says. "I mean, all of a sudden I feel like I rang the bell!"

But now that Carriere's body has adjusted to her smaller self, she'll lose weight more slowly than at the beginning of her diet. Unless, of course, she does something different. And that's exactly what she plans on doing. In addition to her daily walking, she'll add a Zumba exercise class. "It's the only thing that I've ever done that when you walk in, people are all smiling, and when you leave an hour later and you're sweating like an old dog, you're still smiling," she says.

Carriere's betting on the Zumba – and smiling — to help shed that final 20 pounds.

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Today, in Your Health, we're going to hear two stories about dieting. First, for people who are working hard to lose weight, actually shedding pounds is a great motivation to stay the course. But often, around four months into a regimen of diet and exercise, the pounds stop coming off.

NPR's Patti Neighmond has this report on the extremely frustrating diet plateau.

PATTI NEIGHMOND, BYLINE: For 62-year-old Susan Carriere, it all started quite a while ago when she had twins.

SUSAN CARRIERRE: I started battling weight, you know, up and down, and just didn't keep it off.

NEIGHMOND: Her weight went up and down for decades. At five-foot-six, when she hit 230 pounds, she decided to enroll in a weight-loss program. Over six months, she lost more than 50 pounds. She was ecstatic. But then things ground to a halt, and the scale, she says, got stuck at 181.

CARRIERRE: It wouldn't move. I was doing the same low-calorie, the same, you know, just about the same food every day.

NEIGHMOND: And the same walking program, but the stagnant scale went on for weeks.

CARRIERRE: You start questioning: Why am I doing it? If I'm not making any progress, you know, what's the point?

NEIGHMOND: Carriere's frustration is echoed by most people, says physiologist Eric Ravussin, a researcher at the Pennington Biomedical Research Center in Baton Rouge, where Carriere enrolled in the weight loss program. Just a 10-pound loss, he says, results in a smaller body that needs less energy to function.

ERIC RAVUSSIN: You are losing a backpack of 10 pounds that you don't have to carry around when you walk, when you go upstairs, or when you get off your chair.

NEIGHMOND: For example, your smaller body may now need 300 fewer calories a day. That means if you were on a 1,500-calorie-a-day diet, you'll now have to go on a 1,200-calorie-a-day diet in order to keep losing weight. On top of that, the body goes into starvation mode, resisting the weight loss, and begins to burn calories more slowly.

RAVUSSIN: And you have the perfect storm. You require less calories, but also you become more efficient. It's like, you know, going from an old Ford to a Prius with a more efficient engine.

NEIGHMOND: A more efficient engine isn't necessarily a bad thing. It means the body has adjusted to its new lower weight.

Dr. Lee Kaplan is an obesity specialist at Massachusetts General Hospital.

DR. LEE KAPLAN: Their diet plateau is their new set point. And so when you go to a healthier diet, your body says: Oh, this is good. Let's live at a lower body fat. Let's live at a lower set point.

NEIGHMOND: But to move below that lower set point, Kaplan says, you have to do something different.

KAPLAN: We try a diet. We try a different diet. We add exercise. We add a different kind of exercise. We encourage better sleep health. We encourage decreased stress.

NEIGHMOND: Inadequate sleep and too much stress often increase appetite. Different things work for different people. But pretty much everyone agrees that exercise - more of it, or adding a different type - works for most people. That's because healthy muscles burn more calories.

KAPLAN: If you're on the treadmill every day, you may burn a couple hundred calories a day from being on the treadmill. But you may burn six or 800 extra calories throughout the rest of the day when you're not on the treadmill, because your body's working better, because bodies with healthy muscles work better.

NEIGHMOND: For some people, simply persevering through the diet plateau works eventually. That's what happened to Susan Carriere. After four weeks of no weight loss, she got on the scale one morning and had dropped three pounds.

CARRIERRE: It's like the icing on the cake. I mean, all of a sudden, I feel like I rang the bell.

NEIGHMOND: But now that Carriere's body has adjusted to her smaller self, her weight loss will be slower than it was at the beginning of her diet. So she's taking Kaplan's advice and trying to do something different: a Zumba class.

CARRIERRE: It is the only thing that I have ever done that when you walk in, people are all smiling. And when you leave an hour later and you're sweating like an old dog, you're still smiling.

NEIGHMOND: And Carriere's hoping Zumba will help her shed that final 20 pounds.